| NPI | 1164882874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LN0000X Nurse Practitioner, Neonatal (Licence: TN 35657) |
| Additional Taxonomies | 163WN0002X Registered Nurse, Neonatal Intensive Care (Licence: TX 796789) |
| 363LN0000X Nurse Practitioner, Neonatal (Licence: TX AP130587) | |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2024-04-22 |